Healthcare Provider Details

I. General information

NPI: 1699849158
Provider Name (Legal Business Name): DEBORAH GAYLE BROOKS AU.D., CCC-A, F-AAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH GAYLE KUPCHIK M.S. -CCC-A

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 SE OCEAN BLVD STE 300
STUART FL
34996-3341
US

IV. Provider business mailing address

2221 SE OCEAN BLVD STE 300
STUART FL
34996-3341
US

V. Phone/Fax

Practice location:
  • Phone: 772-500-3680
  • Fax: 772-361-6870
Mailing address:
  • Phone: 772-500-3680
  • Fax: 772-361-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001980-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1604
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1980-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: